A Photo Essay

I'm not feeling particularly verbose this week. I thought I'd add a video and some pictures to the blog.

This video captures the arrival of an IDF (Indirect Fire) Casualty to the 1980 FST.

1980th FST personnel and MEDEVAC team uploading combat casualty for transport to Bagram

FOB Sharana "Town Square"

1980th FST at work taking care of IDF (Indirect Fire) Casualty 

Pre-Trauma preparation

 

Waiting for MEDEVAC Helicopter and talking things over.

Pizza on the grill night. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Playing practical jokes on the senior enlisted guys may seem like a good idea until you consider the consequences.

Case in point: Plastering the locks of the NCOs in Charlie Med so they need a cast saw to get into their offices. Bad idea...

Retribution....

"The Haircut."

Major Campbell has his sleeves sutured closed.

Not pictured: MAJ Campbell's favorite hat frozen in a 12 pound block of ice.

Incoming Patients: Trauma # 3314, 3315, 3316, 3317, 3318

We are awakened with a pounding on the door. We know, more or less, what that means.

The report we receive is 4 incoming ANA (Afghan National Army) soldiers that were injured after a suicide bomber exploded a VBED (Vehicle Born Explosive Device) outside a ANA-US military outpost.

BBC description of incident.


We have approximately 20 minutes to prepare for the patients’ arrival. The 1980th FST quickly swings into action with everyone preparing their stations for the incoming patients. IV bags are spiked, drugs prepared, supplies prepositioned, and roles/responsibilities are assigned.

For me it’s simple, I’m the anesthesia guy. Today, my CRNA colleague is in the number 1 position, which means I’m the number 2 anesthetist. CRNA number 1 gets the most critical patient with CRNA number 2 taking care of the second most critical patient. I check my monitors, oxygen, drugs, airway supplies, and suction to ensure that I am ready to go. My team (Team 2/Bed 2) does a “huddle” to make sure we are all on the same page. There can be no confusion about what is going to happen when the patients arrive.

Prepositioning of stretchers. We were told to expect 4 patients, we received 5.

Waiting for MEDEVAC.

I filmed the arrival of MEDEVAC. The video stops at 3:06 because it dawned on me that I needed to go inside and take care of patients.

The suicide bomber, for whatever reason, detonated the VBED prior to arriving at the gate. His mistake likely saved numerous lives. After the VBED explosion, the insurgents peppered the outpost with IDF (Indirect Fire). 




Major Randall Moore, CRNA
1980th Forward Surgical Team
FOB Sharana, Afghanistan

Incoming Patient: Trauma #3309

It's a running joke here that the report you receive concerning an incoming patient rarely resembles what comes rolling in the door. It's like a game of telephone-so any information we receive is taken with a grain of salt. The report for trauma patient #3309 was surprisingly accurate. We were told it was going to be an AUP (Afghan Uniformed Police) with a gunshot wound (GSW) to the pelvis. The patient did in fact have a gunshot to his pelvis. The one major inconsistency with the report was the fact that the patient was not an AUP-he was a 12 year old boy.

Waiting for the MEDAVAC helicopter. The gentlemen with the flashlights will inspect the patient for weapons and unexploded ordnance.

From the beginning, the story we received from the patient (via our translator) didn't add up. The child claims to have been shot while watching a firefight from the roof of his home. He was found to have a cell phone (unusual for a 12 year old in Afghanistan) and a live 7.62 mm round in his possession. The trajectory of the projectile is inconsistent with the explanation of events. Clearly there is more to the story.

ATLS Station. Initial evaluation and resuscitation. Our medics are establishing IV access while the surgeon and CRNA assess the patient.

A GSW to the pelvis is an extraordinarily dangerous injury. There are a number of rather large blood vessels that are located in this area, and damage to any one of them can be life threatening. We were prepared for the worst but hoping for the best.

If you look closely, you can see the entrance wound by the surgeon's left hand. The exit wound is posterior-lateral right buttock area.

Believe it or not, this kid was lucky. If the bullet had traveled one inch in either direction, he would likely not have made it to us alive.

This is typical of Afghanistan. You rarely get the whole story. I still don't know the circumstances of why or how this child was shot. Likely, the child was obfuscating to protect either himself or someone else. What I do know is that this is the second child we've taken care of in less than two weeks that suffered a gunshot wound. Sadly, this is not an anomaly in Afghanistan. In the US, a child getting shot is a tragedy. In Afghanistan, it's just another day.


Major Randall Moore, CRNA
1980th Forward Surgical Team
FOB Sharana, Afghanistan

Life on the FOB

Living on a FOB (Forward Operating Base) is an interesting experience. A FOB is a secured forward military position, commonly a military base, that is used to support tactical operations. My current location, FOB Sharana, is located in eastern Afghanistan near the Pakistan border. Our location is strategically important for a number of reasons. Unfortunately, I really can't tell you any of those reasons. Suffice it to say, Pakistan is very close, and that is not a coincidence.

FOB Sharana is an incredibly active military base. There is a constant hum of activity with all kinds of military vehicles and aircraft (both manned and unmanned aircraft) operating 24 hours a day. There are a variety of military units at FOB Sharana. Some I can talk about, and others that shall remain nameless. The following is a small collection of random photos for your viewing pleasure.

Believe it or not, the Soviet Union used this exact piece of real estate during their failed invasion of Afghanistan. The guard tower and walls you see here were constructed by the Russians. Thanks fellas...

The quality of this gym is amazing considering our remote location. The food is terrible, but the gym is nice.

Speaking of the gym. There is a contingent of Polish special forces here. They like to hang out at the gym and all of them look like this. This is the look I get when I get too close to them.

"I will crush you"

Coca-Cola Zero: Canned in Kabul! I drank it anyway.

This is one of the two "poop ponds." Admittedly I'm not an environmental scientist, but I've yet to comprehend why we have two ponds of "you know what" just festering in the middle of the FOB. I've asked a number of people about this and I just get a shrug of the shoulders and comments like "who knows, it's the army." Apparently, there is a sign by each of the ponds that states "No Fishing!" 

La poop pond. The smell is glorious.

Joe Alderete, our orthopedic surgeon, climbing on the tail of a Blackhawk for no apparent reason. You just have to know Joe. Joe will be leaving us in a few days and he will be greatly missed.

(Photo Credit: Grant Campbell) "Dust Off"departing (minus Joe) after patient delivery.

I would like to conclude this post on a more serious note. Pictured below is an Apache attack helicopter. If you are a bad guy, this is the last thing you want hunting you down. This week, within a 24 hour period, our Apache helicopters from FOB Sharana killed 57 Taliban insurgents. I realize that the news in the US rarely covers it anymore, but there still is a war on. Almost everyday an American loses his or her life here in Afghanistan.

Death from above.

Major Randall Moore, CRNA
1980th Forward Surgical Team
FOB Sharana, Afghanistan

Hearts and Minds

Providing medical care in a combat environment is challenging on multiple levels. The most difficult aspect, in my opinion, is having to turn away people that need care but do not meet the Medical Rules of Engagement (MROE). This is an incredibly complex issue. As many of you may know, we are technically in a draw down. That is to say, we are gradually going to decrease our military foot print in Afghanistan with the goal of eliminating all combat forces by the end of 2014. This smaller foot print will also lead to a decreased availability of US medical personnel and resources. As part of this process, we are insisting that than Afghans take a larger role in taking care of their wounded, both military/police and civilian. Therein lies the moral dilemmas we have to face here at FOB Sharana.
The 1980th FST is in the process of creating a mentoring program with local Afghan physicians. Just yesterday, we did two operative cases with an Afghan "Anesthesia Technician" and surgeons. The goal is to impart knowledge, to some degree, so that these medical professionals can better take care of their countrymen after we leave.

Afghans are more like us than not. They are a proud people that want nothing more than dignity, respect, and peace. Unfortunately, the Afghan society has been decimated by countless years of war, corruption, and systemic dysfunction. The country lacks a basic societal infrastructure, and over half of its "citizens" live in abject poverty. For decades the international community has vacillated between ignoring the plight of Afghans or exploiting them for the purpose of geopolitical point scoring. As with all wars, it is the innocent that suffer the most.

This series of photos was taken during an induction sequence with an Afghan anesthesia provider. I was serving as his mentor. The patient is a 11 year old boy that was shot through the upper arm with an exit wound through the axilla. His humerus was fractured mid-shaft. The photos uploaded a little goofy, but you get the point nonetheless.

I elected to use a supraglottic airway. The child was shot approximately 24 hours prior to our encounter and was NPO.

This was my counterparts first opportunity to use a LMA.

We did an extensive irrigation and debridement as well as a definitive closure of wounds. A drain was placed and the upper arm was placed in a cast.

Major Randall Moore, CRNA
1980th Forward Surgical Team
FOB Sharana, Afghanistan

A follow-up to my wounded handler and dog post

Just a quick follow-up to my previous post, "not all of our patients are human." I was made aware of the following article just recently published by the Wounded Warrior Project.

http://www.army.mil/article/87806/Working_dog_reunites_with_handler_during_bedside_hospital_visit/

I can't tell you how happy we are at the 1980th FST to see this. Amazing..no words.

From this...

To this..

Life in a Forward Surgical Team

Life in a FST (Foward Surgical Team) is often describe as hours and hours of boredom followed by moments of chaos and terror. The patients we receive are "fresh." In other words, they've been recently injured. It is not uncommon for the patients to arrive with IO (intraosseous) access because the medics were unable to obtain IV access. Sometimes we get a 30 minutes heads-up, sometimes it's 5 minutes. The injuries are often profound. More often than not, I intubate and anesthetize the patient within moments of arrival in order to ameliorate his pain and allow for a thorough examination of his wounds. As I alluded to in a previous post, IED injuries are complex and challenging to treat. Unlike a gunshot wound (GSW), IED injuries tend to have a "peppering" pattern with multiple areas of penetration. Also, many of these penetrating wounds can potentially be life-threatening. Our job, as a FST, is to resuscitate and stabilize the patient in the immediate aftermath of injury. Often this requires emergent surgical intervention. Most penetrating wounds to the abdomen, chest, and neck require surgical exploration. The orthopedic injuries caused by IEDs can be devastating and often require external fixation by our orthopedic surgeon. Our goal is to stabilize the patient for expeditious evacuation to a more definitive level of care.

On a personal note, I am in good spirits and doing well. I'm getting into the routine here. I try to run almost everyday and I am reading more than I have in years. I'm almost done with season two of Breaking Bad and I talk to my family almost every day. I've learned quickly that the key to staying sharp is being mentally and physically active.

Thank you for reading.

Most of the 1980th FST Health Care Providers. Steak and lobster night!

Me

My roommate: Major Campbell, MD. His hobbies include getting haircuts and receiving mail.

Major Randall Moore, CRNA
1980th Forward Surgical Team
FOB Sharana, Afghanistan